How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment

Wang, Xin; Song, Kuimeng; Zhu, Paiyi; Valentijn, Pim; Huang, Yixiang; Birch, Stephen

doi:10.3390/ijerph17010117

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…To facilitate consistent understanding and the design of policy interventions, [ 39 , 40 ], we recommend future studies to clearly define and present their attributes (e.g. as a table in Wang et al [ 41 ]).…”

Section: Discussionmentioning

confidence: 99%

Conjoint analyses of patients’ preferences for primary care: a systematic review

Lim

Teh

et al. 2022

BMC Prim. Care

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Background While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits. Methods We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings. Results Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender). Conclusions We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them. Word Count: 346/350 words. Trial registration On Open Science Framework: https://osf.io/m7ts9

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Section: Discussionmentioning

confidence: 99%

Conjoint analyses of patients’ preferences for primary care: a systematic review

Lim

Teh

et al. 2022

BMC Prim. Care

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“…43 Similarly, multidisciplinary care became an attribute in a DCE that measured preferences for urban integrated primary care among type 2 diabetes patients. 44 As a result, we defined continuity of care as the healthcare facility operating in a wellfunctioning care delivery system, which could provide coordinated healthcare services for patients. 43 Attributes and levels of healthcare services that were used in our DCE were shown in table 1.…”

Section: Identification Of Attributes and Levelsmentioning

confidence: 99%

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

Bao

Shi

et al. 2021

BMJ Open

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ObjectivesOur study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.DesignWe identified six attributes of healthcare services for a discrete choice experiment (DCE), and applied Bayesian-efficient design with blocking techniques to generate choice sets. After conducting the DCE, we used a mixed logit regression model to investigate patients’ preferences for each attribute and analysed the heterogeneities in preferences. Estimates of willingness to pay were derived from regression coefficients.SettingThe DCE was conducted in Jiangsu province and Shanghai municipality in China.ParticipantsPatients aged 18 years or older with a history of hypertension for at least 2 years and who took medications regularly were recruited.ResultsPatients highly valued healthcare services that produced good treatment effects (β=4.502, p<0.001), followed by travel time to healthcare facilities within 1 hour (β=1.285, p<0.001), and the effective physician–patient communication (β=0.771, p<0.001). Continuity of care and minimal waiting time were also positive predictors (p<0.001). However, the out-of-pocket cost was a negative predictor of patients’ choice (β=−0.168, p<0.001). Older adults, patients with good health-related quality of life, had comorbidities, and who were likely to visit secondary and tertiary hospitals cared more about favourable effects (p<0.05). Patients were willing to pay ¥2489 (95% CI ¥2013 to ¥2965) as long as the clinical benefits gained were substantial.ConclusionsOur findings highlight the importance of effective, convenient, efficient, coordinated and patient-centred care for chronic diseases like hypertension. Policy-makers and healthcare providers are suggested to work on aligning the service provision with patients’ preferences.

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“…The DCE is a stated preference approach that has been popular when measuring preferences in the healthcare field 17. To the best of our knowledge, there has only been one study conducted in China to look at the preferences of patients with type 2 DM for urban integrated primary care 18. However, the above study focused on urban patients with a well-developed health system in China and could not represent the broad patient population.…”

Section: Introductionmentioning

confidence: 99%

“… 17 To the best of our knowledge, there has only been one study conducted in China to look at the preferences of patients with type 2 DM for urban integrated primary care. 18 However, the above study focused on urban patients with a well-developed health system in China and could not represent the broad patient population. Our study is more comprehensive than before in that the sample includes a mix of rural and urban areas.…”

Section: Introductionmentioning

confidence: 99%

Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China

Qin

Feng

et al. 2023

BMJ Open

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ObjectivesTo quantify the preference of patients with diabetes mellitus (DM) for primary healthcare (PHC) institutions in China to redirect the patient flow and improve health outcomes.DesignCross-sectional study. Discrete choice experiment (DCE) surveys asked patients with DM to choose between hypothetical institutions that differed in the medical service capacity, out-of-pocket (OOP) medical costs per month, travel time, the attitude of medical staff and the availability of diabetes drugs.SettingShandong province, China.ParticipantsThe participants were 887 patients with DM from 36 urban communities and 36 rural villages in Shandong province. One participant did not provide any DCE answers and a further 57 patients failed the internal consistency test. 829 fully completed surveys were included in the final data analysis.Main outcomes and measuresA mixed logit model was used to calculate the willingness to pay and predict choice probabilities for PHC institution attributes. Preference heterogeneity was also investigated.ResultsAll five attributes were associated with the preferences of patients with DM. The OOP medical costs and the medical service capacity were the most influential attributes. Improvements simultaneously in the attitude of medical staff, drug availability and travel time increased the likelihood of a patient’s PHC institution choice. Preferences differed by region, annual household income and duration of diabetes.ConclusionsOur patient preference data may help policymakers improve health services and increase acceptance of choosing PHC institutions. The OOP medical costs and medical service capacity should be regarded as a priority in decision-making.

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How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment

Cited by 6 publications

References 25 publications

Conjoint analyses of patients’ preferences for primary care: a systematic review

Conjoint analyses of patients’ preferences for primary care: a systematic review

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China

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